Improved Measurement

Health systems founded on strong primary health care are essential to achieve the Sustainable Development Goals and universal health coverage. Authors on behalf of the World Organization of Family Doctors' (WONCA) executive committee discuss the need for global primary care development indicators to strengthen primary health care systems. They call on the UN and other stakeholders to commit to the measurement and development of high-quality and comprehensive primary care. 

Recent crises, including the Ebola epidemic in West Africa, have been wake-up calls: too many primary health care systems are under-resourced and fragmented, leaving countries unprepared to reach everyone with needed health services. Read more for a call to action from leadership of The Bill & Melinda Gates Foundation, the World Bank Group, and the World Health Organization on the need for better measurement to guide meaningful improvements in primary health care systems.

On September 26, 2015 on the sidelines of the United Nations General Assembly, the Bill & Melinda Gates Foundation, the World Bank Group, and the World Health Organization launched a collaboration to strengthen primary health care and advance progress toward the Sustainable Development Goals.

With the launch of the new Sustainable Development Goals, health and development experts around the world are reflecting on what it will take to accomplish them. As a global community, this is a unique opportunity to think carefully about what works and what doesn’t, and to use the new goals to redouble our efforts to support programmes, solutions, and systems that work. Suzanne Ehlers, President and CEO of Population Action International, and Rosemary Mburu, Executive Director of World AIDS Campaign International, weigh in on the value of high-performing primary health care systems and call on country decision-makers to enact policies and budgets that lead to measureable improvements in primary health care.

What makes primary health care work? How can systems better function as a whole? Atul Gawande and Chris Elias speak with Devex about the challenges primary health care leaders face around the world, and how PHCPI is digging deep to understand these difficult questions.

Last month, world leaders came together to adopt the Sustainable Development Goals (SDGs)--a new global development agenda that sets ambitious targets, such as eliminate poverty, achieve gender equality and end hunger globally. Following the launch of the SDGs, World Organization of Family Doctors (WONCA) President Michael Kidd weighs in on the potential of primary health care systems to support the achievement of the health-related SDG and deliver quality health care to populations worldwide. He also proposes new indicators that, if comprehensively measured, can show us the strength of primary health care in countries around the world and help us understand how to further improve our systems.

Imagine traveling an hour to reach a health facility, only to realize that no doctors are there. Or taking medication for a month, to later find out that you received the wrong diagnosis. Imagine being a doctor at a clinic so busy you see over 40 patients a day, and aren't able to give each one the full attention they need. Good health workers are the cornerstone to strong health systems. PHCPI investigates how we can better understand what makes health care providers most effective for the patients they serve. 

When you go to a health facility, are you able to see the same doctor or nurse as the last time you visited? If you see a specialist, do they use information from your primary care doctor to inform your diagnosis and treatment? Are you referred to a higher-level facility, if necessary, for follow-up care? For some of us, the answer is yes. But for too many of us, the answer is no. Read on to find out why continuity of care is a critically important, but poorly understood, role of PHC systems.

Strengthening primary health care (PHC) is essential to achieve universal health coverage and the health-related Sustainable Development Goals, and PHC system strengthening requires good measurement. The PHC Measurement for Improvement Collaborative, launched in April 2016 in Accra, Ghana by the Joint Learning Network for Universal Health Coverage and the Primary Health Care Performance Initiative, will co-develop practical tools and approaches – drawing on collective country experiences—to support country policymakers, health system managers, and frontline providers to effectively use data for PHC improvement.

Over the last 15 years, Chile has developed a national shared monitoring plan for tracking the performance of its primary health care system. The plan consists of two parsimonious indicator sets: the Health Goals, which provide an economic incentive for frontline providers to meet service delivery targets, and the Activity Indicators, which increase financial transparency and ensure that municipalities are accountable for the health of their population. The process of data collection, review, and feedback is standardized throughout the country, and annual meetings allow for targets to be updated according to local needs. Chile’s monitoring system is an excellent example of how diverse stakeholders can work together to establish a simple method for assessing the overall performance of a primary health care system to promote accountability, incentivize quality, and drive improvement. 

Why is data so important to the success of health systems? The UCSF Global Health Sciences illustrates how data makes invisible people and problems visible, and is absolutely critial for health systems success. 

The JLN Primary Health Care Improvement Collaborative met in Kigali, Rwanda to outline strategies to address priority measurement areas and work towards the creation of a practical measurement toolkit.

As the 70th World Health Assembly (WHA) meeting comes to a close, it is important to recognize that dialogue among country actors and the global community is critical for collective progress. In this open letter to WHA delegates, members of the Joint Learning Network for Universal Health Coverage Primary Health Care Measurement for Improvement Collaborative share key insights on the need to better measure and strengthen primary health care systems.

Join us for an interactive community consultation on measurement for improvement in quality primary health care. We want to hear your perspectives and ideas!

The Improvement Strategies are a novel interactive knowledge management tool that health ministries, development partners, facility managers, advocates, and others can use to learn about the best evidence for improving primary health care and find practical recommendations for adapting these strategies to their context. They are designed to support users along their measurement to improvement journey.